Newport Beach Campus Tutoring Fill out the registration form below and complete your payment to sign up today! Feel free to ask us for guidance on filing your application: email@example.com. Step 1 of 4 25% Email* #1 Student Name*#1 Date of Birth* Date Format: MM slash DD slash YYYY #1 Gender*FemaleMale#1 In which grade is your child?*TKK1st2nd3rd4th5th6th7th8th9th10th11th12thN/AYour child may register for classes outside of their grade level. However, we enroll based on age-based grade level.Which subject you are interested? **MathematicsMandarin ChineseEnglishOthers What is your time availability for tutoring?*Name of Primary Parent*Who is the financially responsible parent or guardian?*Please have that person complete the remainder of this application.Email of Primary Parent:* Cell Phone of Primary Parent*Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Second ParentEmail of Second Parent: Cell Phone of Second ParentEmergency Contact Name & Relationship to Student*Emergency Contact Phone* Seashore Policies and Release Agreement We are so excited to welcome you to our community. Please read through all the policies and sign below to accept all. Your electronic signature is equally binding as a manual signature.Activity Release I acknowledge and agree as follows: 1. Participation in Seashore Academy is voluntary and is a privilege. 2. I release, absolve and hold harmless Seashore Academy, its owner, officers, agents, volunteers or employees from any and all liability for any claim arising out of traveling to/from, participating in, or which is in some manner connected with, the participation of my child(ren) in any Seashore program or affiliate. 3. Students and parents are required to obey all rules and safety requirements, as well as Seashore standards for respect of persons and property. 4. I hereby give my approval for the participation of my child(ren) in any and all Seashore programs. Medical Release In the event of a medical emergency, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of my child(ren). Permission is also granted to Seashore Academy and its affiliates including its owner, teachers, staff and volunteers to provide the needed emergency treatment prior to the child’s admission to the medical facility. I understand that Seashore does not have a nurse on site. In the case any special medical needs, such as regular insulin injections, I may make special arrangements with Seashore staff to administer treatment. In the case of allergies, I must train my child to avoid sharing food (Seashore discourages this practice, but we cannot be responsible if a child accepts a food item to which he/she is allergic.) This release is authorized with the purpose of authorizing medical treatment for the protection of my child(ren) in my absence. COVID-19 RISKS: I understand that my child(ren)’s participation with in-person services during a health pandemic may result in my child contracting COVID-19, which may be spread to me and my family, which may result in severe illness, hospitalization and/or death. By signing hereon, the parent/guardian waives liability against and holds harmless the Seashore staff, participants, and owners relating to the contraction of COVID-19 to the student or his/her family. If the student/parent/guardian believes that an unsafe condition or circumstance exists with respect to the activity(ies), students may discontinue in-person participation and join the virtual services.Photographic Release Seashore Academy often takes photographs or videos of child(ren) during its classes, activities and events. I grant permission without compensation that these photographs or videos may be used in to promote Seashore Academy. Seashore agrees to not identify me or my child(ren) by name, or release any other personal information without additional written permission from me.Financial Agreement Registration Fee, non-refundable I hereby enroll my child(ren) in Seashore Academy. We accept cash, credit cards, check, PayPal, and charter funds. I understand that I am responsible for making payments until any charter funds arrive (if applicable), at which time Seashore will apply these funds to my account, and issue me a refund check for overpayment (if applicable). I agree to pay the tuition and fees as outlined. I understand and acknowledge that Seashore Academy is a learning center of limited enrollment, and that in accepting this enrollment and tuition agreement form together with the non-refundable registration fee, Seashore agrees to provide a place for my child(ren. I understand that a late fee of $100 on any past due balance shall be charged for any payments not made by the 20th of the month due per the designated installment plan. I also understand that the returned check fee is $25 per returned check or failed transaction. I further understand and agree that the registration fee is non-refundable. I understand that Seashore Academy may offer to accept applicable instructional funds on behalf of charter schools for my child(ren), but that I remain financially responsible for all fees if/when charter funds are not successfully obtained for any reason. Once charter funds are deposited by Seashore and there is overpayment on my account, Seashore will issue me refund. The undersigned parents or guardians hereby agree that Seashore Academy shall at all times have the right with or without cause in its sole discretion to dismiss or expel the above-named student(s) or refuse to enroll such student(s) for any succeeding school year. No reduction or reimbursement is made for the withdrawal, dismissal, or absence of a student during the term for whatever reason, excepting the death or incapacity of my child(ren). I further specifically agree to waive any claim against Seashore Academy for any losses or damages in any way associated with Seashore’s refusal to enroll the above named student(s) for any succeeding school year. In the event it becomes necessary to institute legal action to reinforce the terms of this agreement, I agree that the matter shall be determined only by binding arbitration, according to the rules of the American Arbitration Association and, in the event that the school prevails in such action, I will pay the reasonable costs of that action, including reasonable attorneys fees incurred. By my signature(s) below and on the attached contract, I certify that I have read and understand the terms stated in this agreement and its addendum and agree thereto. Any cancellation request must be made in writing to firstname.lastname@example.org. Phone or text requests will not be honored. ZOOM cancellations shall be processed the Saturday following the request. Full time students' cancellation requests will be honored after the 60 day written notice.Termination of Enrollment Seashore Academy reserves the right to accept, deny or terminate enrollment of students solely at its discretion. The following are some (but not all) reasons that Seashore Academy would be inclined to terminate enrollment: delinquent or non-payment of tuition, behavior problems by parent, family member or student, or repeated failure to pick up your sick child within one hour of being notified. Parents wishing to withdraw their child(ren) must provide 60 days’ written notification.Parent Communication Parent-teacher conferences may be scheduled in October and in March. If you wish to speak with your child’s teacher, please make an appointment with the Director via email. Our teachers are busy supervising the safety of many children and families during instructional time as well as before and after school. Dedicated time to address questions and concerns allows for more thoughtful communication between families and school staff. Parents and extended family members are welcome to observe classes. To minimize distractions, we do not allow younger siblings into the classroom. Observations need to be scheduled via email with 48 hours' notice, at a mutually convenient time, be limited to 20 minutes in duration, not more than twice per month. Parental volunteers are not permitted to be in the classroom. To protect the privacy of the school community, video recording of students is not permitted except during formal presentations. Please refrain from taking photos of children who are not your own. Posting photos of other children on social media is strictly forbidden. Pick Up Policy If someone other than the legal parents are to pick up a student, notification must be given via email 24 hours prior. In addition, all drivers need to present a government ID to staff. If a child is not picked up at the end of the after-school program, there will be a 10 min. grace period and a $1/min charge thereafter.Signature*By signing below, you acknowledge that you have read, understood and agree to all of the policies, releases and the financial agreement. Your electronic signature below will have the same effect and be as equally binding as a manual signature. You are also agreeing to be responsible for all aspects of the above policies for the child(ren), if enrolled, including tuition payments. Available Packages Tutoring*Private Tutoring Sessions - 1 Session - $65Private Tutoring Sessions 10- 10 Sessions - $595Total $0.00 Pay with your credit card (Stripe)* Card Details Cardholder Name NameThis field is for validation purposes and should be left unchanged.